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Rades D, Cremers F, Janssen S, Bartscht T, Kristiansen C, Timke C, Duma MN, Yu NY, Bohnet S. Associations Between Mean Lung Dose and Prevalence of Radiation Pneumonitis in Elderly Lung Cancer Patients. Anticancer Res 2024; 44:2073-2079. [PMID: 38677766 DOI: 10.21873/anticanres.17011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/01/2024] [Accepted: 03/04/2024] [Indexed: 04/29/2024]
Abstract
BACKGROUND/AIM Pneumonitis is a serious radiotherapy complication. This study, which is a prerequisite for a prospective trial, aimed to identify the prevalence of pneumonitis and risk factors in elderly patients with lung cancer. PATIENTS AND METHODS Ninety-eight lung cancer patients aged ≥65 years were included. Seventeen factors were investigated regarding grade ≥2 pneumonitis at 24 weeks following radiotherapy. RESULTS The prevalence of grade ≥2 pneumonitis at 24 weeks was 27.3%. On univariate analysis, a significant association was observed for mean (ipsilateral) lung dose (MLD; ≤13.0 vs. 13.1-20.0 vs. >20.0 Gy; 0% vs. 24.9% vs. 48.7%). Results were significant also for ≤13.0 vs. >13.0 Gy (0% vs. 37.1%) or ≤20.0 vs. >20.0 Gy (13.4% vs. 48.7%). MLD achieved significance on multivariate analysis. CONCLUSION Elderly patients receiving MLDs >13.0 Gy, particularly >20.0 Gy, have a high risk of grade ≥2 pneumonitis. These results are important for designing a prospective trial.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Florian Cremers
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Department of Radiation Oncology, University Medical Center Schleswig-Holstein, Lübeck, Germany
| | - Tobias Bartscht
- Department of Hematology, Oncology and Stem Cell Transplantation, Medical School Hamburg, Schwerin, Germany
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
| | - Charlotte Kristiansen
- Department of Oncology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Carmen Timke
- Department of Radiotherapy, Malteser Hospital St. Franziskus, Flensburg, Germany
| | - Marciana N Duma
- Department for Human Medicine, MSH Medical School Hamburg, Hamburg, Germany
- Department of Radiotherapy, Medical School Hamburg, Schwerin, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
- Department of Pulmonology, University Medical Center Schleswig-Holstein, Lübeck, Germany
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Kuempers C, Jagomast T, Paulsen FO, Heidel C, Bohnet S, Schierholz S, Reischl M, Dreyer E, Olchers T, Reck M, Kirfel J, Perner S. TRIM11 expression in non-small cell lung cancer is associated with poor prognosis. Histol Histopathol 2024; 39:437-446. [PMID: 37409491 DOI: 10.14670/hh-18-647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/07/2023]
Abstract
BACKGROUND Despite promising results of targeted therapy approaches, non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related death. Tripartite motif containing 11 (TRIM11) is part of the TRIM family of proteins, playing crucial roles in tumor progression. TRIM11 serves as an oncogene in various cancer types and has been reported to be associated with a poor prognosis. In this study, we aimed to investigate the protein expression of TRIM11 in a large NSCLC cohort and to correlate its expression with comprehensive clinico-pathological data. METHODS Immunohistochemical staining of TRIM11 was performed on a European cohort of NSCLC patients (n=275) including 224 adenocarcinomas and 51 squamous cell carcinomas. Protein expression was categorized according to staining intensity as absent, low, moderate and high. To dichotomize samples, absent and low expression was defined as weak and moderate and high expression was defined as high. Results were correlated with clinico-pathological data. RESULTS TRIM11 was significantly more highly expressed in NSCLC than in normal lung tissue and significantly more highly expressed in squamous cell carcinomas than in adenocarcinomas. We found a significantly worse 5-year overall survival for patients who highly expressed TRIM11 in NSCLC. CONCLUSIONS High TRIM11 expression is linked with a poor prognosis and might serve as a promising novel prognostic biomarker for NSCLC. Its assessment could be implemented in future routine diagnostic workup.
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Affiliation(s)
- Christiane Kuempers
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Tobias Jagomast
- Medical Clinic III, Pulmonology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Finn-Ole Paulsen
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Heidel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Department of Haematology and Oncology, Sana Hospitals, Luebeck, Germany
| | - Sabine Bohnet
- Medical Clinic III, Pulmonology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Stefanie Schierholz
- Department of Surgery, Medical University of Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Markus Reischl
- Institute for Automation and Applied Informatics, Karlsruhe Institute of Technology, Eggenstein-Leopoldshafen, Karlsruhe, Germany
| | - Eva Dreyer
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Till Olchers
- Department of Thoracic Oncology, LungenClinic Grosshansdorf, Großhansdorf, Germany
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf, Großhansdorf, Germany
- Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Großhansdorf, Germany
| | - Jutta Kirfel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sven Perner
- Institute for Hematopathology Hamburg, Hamburg, Germany
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Pasternack H, Polzer M, Gemoll T, Kümpers C, Sauer T, Lazar-Karsten P, Hinrichs S, Bohnet S, Perner S, Dressler FF, Kirfel J. Proteomic analyses identify HK1 and ATP5A to be overexpressed in distant metastases of lung adenocarcinomas compared to matched primary tumors. Sci Rep 2023; 13:20948. [PMID: 38016997 PMCID: PMC10684588 DOI: 10.1038/s41598-023-47767-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 11/17/2023] [Indexed: 11/30/2023] Open
Abstract
Lung cancer is the leading cause of cancer-related deaths worldwide with lung adenocarcinoma (LUAD) being the most common type. Genomic studies of LUAD have advanced our understanding of its tumor biology and accelerated targeted therapy. However, the proteomic characteristics of LUAD are still insufficiently explored. The prognosis for lung cancer patients is still mostly determined by the stage of disease at the time of diagnosis. Focusing on late-stage metastatic LUAD with poor prognosis, we compared the proteomic profiles of primary tumors and matched distant metastases to identify relevant and potentially druggable differences. We performed high-performance liquid chromatography (HPLC) and electrospray ionization tandem mass spectrometry (ESI-MS/MS) on a total of 38 FFPE (formalin-fixed and paraffin-embedded) samples. Using differential expression analysis and unsupervised clustering we identified several proteins that were differentially regulated in metastases compared to matched primary tumors. Selected proteins (HK1, ATP5A, SRI and ARHGDIB) were subjected to validation by immunoblotting. Thereby, significant differential expression could be confirmed for HK1 and ATP5A, both upregulated in metastases compared to matched primary tumors. Our findings give a better understanding of tumor progression and metastatic spreads in LUAD but also demonstrate considerable inter-individual heterogeneity on the proteomic level.
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Affiliation(s)
- Helen Pasternack
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Mirjam Polzer
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Institute of Legal Medicine, University Hospital Münster, Münster, Germany
| | - Timo Gemoll
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Christiane Kümpers
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Thorben Sauer
- Section for Translational Surgical Oncology and Biobanking, Department of Surgery, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Pamela Lazar-Karsten
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sofie Hinrichs
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Pathology, Research Center Borstel, Leibniz Lung Center, Borstel, Germany
- Institute of Pathology and Hematopathology, Hamburg, Germany
| | - Franz Friedrich Dressler
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany
- Institute of Pathology, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Jutta Kirfel
- Institute of Pathology, University Hospital Schleswig-Holstein, Campus Luebeck, Luebeck, Germany.
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Rades D, Delikanli C, Janssen S, Bohnet S, Yu NY. Distress Scores During Radiotherapy for Lung Cancer: Course and Prognostic Factors. Cancer Diagn Progn 2023; 3:577-581. [PMID: 37671309 PMCID: PMC10475928 DOI: 10.21873/cdp.10257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 07/28/2023] [Indexed: 09/07/2023]
Abstract
Background/Aim Cancer treatment can lead to significant distress. We investigated the course of distress during radiotherapy (RT) for lung cancer. Patients and Methods Data of 159 patients receiving RT for lung cancer were investigated for change of distress scores during RT. Five characteristics were analyzed including age, sex, Karnofsky performance score, intent of RT, and receipt of previous RT. Additional analyses were performed in patients with pre-RT scores ≤5 points. Results Mean pre-RT and post-RT distress scores were 5.5 (±2.6) and 4.7 (±2.6), respectively. No characteristic was significantly associated with mean change or increase of distress. In patients with pre-RT scores ≤5 points, non-significantly higher rates of increased distress were found for age ≤64 years, female sex, and Karnofsky performance score 90-100. Conclusion Distress is reduced during a course of RT for lung cancer. This may reflect a reduction in anticipatory distress after first-hand experience.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Cansu Delikanli
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, Hannover, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
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Probst E, Franzen KF, Idel C, Plötze-Martin K, Fleckner J, Rades D, Bohnet S, Bruchhage KL, Pries R. Differential Effects of Anti-PD-1/PD-L1 Checkpoint Inhibitors on Adhesion Molecules and Cytokine Secretion by THP-1 Monocytes. Anticancer Res 2023; 43:2445-2454. [PMID: 37247886 DOI: 10.21873/anticanres.16412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 05/31/2023]
Abstract
BACKGROUND/AIM Immune checkpoint inhibitors have improved the treatment regimen for human cancers in recent years. Particularly, inhibitors of the checkpoint molecules PD-1/PD-L1 have emerged as promising therapeutic treatments by preventing T-cell anergy and exhaustion. However, the impact of different anti-PD-1/PD-L1 checkpoint inhibitors on human monocytes remains elusive. MATERIALS AND METHODS In this study, using the human monocyte leukemia cell line THP-1 as a model, we investigated the influence of different therapeutic anti-PD-1/PD-L1 checkpoint inhibitors on monocytic adhesion molecule expression and cytokine secretion. THP-1 monocytes were treated with the anti-PD-1 checkpoint inhibitors Nivolumab and Pembrolizumab and anti-PD-L1 checkpoint inhibitors Atezolizumab and Durvalumab. Cytokine expression patterns were evaluated using cytokine arrays and enzyme-linked immunosorbent assays (ELISA) and analysis of adhesion molecules was addressed using flow cytometry. RESULTS Our data show an overall moderate apoptosis induction upon checkpoint inhibitor treatment and significantly reduced expression levels of adhesion molecules CD29, CD49d, and CX3CR1 in response to anti-PD-1 treatment. Cytokine screening revealed overall decreased secretion levels of insulin-like growth factor binding protein 2 (IGFBP2), CD147 (basigin) and CD31 (PECAM-1) as well as elevated levels of interleukin 5 (IL-5) and interferon gamma (IFNγ) in response to checkpoint inhibitor treatment. CONCLUSION Our data indicate differential effects of anti-PD-1/PD-L1 checkpoint inhibitors on THP-1 monocytes, both by specific anti-PD-1/PD-L1 binding and unspecific antibody IgG isotype recognition. Further investigations on peripheral blood monocyte subsets in terms of their expansion and function upon checkpoint inhibitor therapy are required to better understand the individual immunological balances in cancer patients in long-term observational studies.
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Affiliation(s)
- Eva Probst
- Department of Medical Clinic III, University of Lübeck, Lübeck, Germany
| | - Klaas F Franzen
- Department of Medical Clinic III, University of Lübeck, Lübeck, Germany
| | - Christian Idel
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Kirstin Plötze-Martin
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Jonas Fleckner
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Medical Clinic III, University of Lübeck, Lübeck, Germany
| | - Karl-Ludwig Bruchhage
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany
| | - Ralph Pries
- Department of Oto-Rhino-Laryngology and Head and Neck Surgery, University of Lübeck, Lübeck, Germany
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Rades D, Al-Salool A, Bohnet S, Yu NY. Prevalence of and Risk Factors for Emotional Distress in Patients Undergoing Radiotherapy for Lung Cancer. Anticancer Res 2023; 43:2111-2118. [PMID: 37097662 DOI: 10.21873/anticanres.16372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 03/08/2023] [Accepted: 03/09/2023] [Indexed: 04/26/2023]
Abstract
BACKGROUND/AIM Quality of life of patients with lung cancer can be impaired by psychological distress. This study evaluated prevalence of and risk factors for emotional distress in patients undergoing radiotherapy or chemoradiotherapy. PATIENTS AND METHODS Fourteen potential risk factors were retrospectively investigated in 144 patients. Emotional distress was evaluated with the National Comprehensive Cancer Network Distress Thermometer. Values of p<0.0036 (Bonferroni correction) were considered significant. RESULTS At least one emotional problem (worry, fear, sadness, depression, nervousness, loss of interest) was reported by the majority of patients (N=93, 65%). Prevalence of these problems was 37%, 38%, 31%, 15%, 32% and 23%, respectively. Physical problems were significantly associated with worry (p=0.0029), fear (p=0.0030), sadness (p<0.0001), depression (p=0.0008), nervousness (p<0.0001), and loss of interest (p<0.0001). Age ≤69 years was associated with worry (p=0.0003), and female sex with fear (p=0.0002) and sadness (p=0.0026). Trends were found for associations of age with sadness (p=0.045), female sex with nervousness (p=0.034), and chemoradiotherapy with worry (p=0.027). CONCLUSION Many patients with lung cancer experience emotional distress. Early psycho-oncological assistance may be important, particularly for high-risk patients.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Ahmed Al-Salool
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Nathan Y Yu
- Department of Radiation Oncology, Mayo Clinic, Phoenix, AZ, U.S.A
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Rades D, Werner EM, Glatzel E, Bohnet S, Schild SE, Tvilsted SS, Janssen S. Early Identification of Pneumonitis in Patients Irradiated for Lung Cancer-Final Results of the PARALUC Trial. Cancers (Basel) 2023; 15:cancers15020326. [PMID: 36672276 PMCID: PMC9856605 DOI: 10.3390/cancers15020326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 12/29/2022] [Accepted: 12/30/2022] [Indexed: 01/05/2023] Open
Abstract
Radiotherapy of lung cancer may cause pneumonitis that generally occurs weeks or months following therapy and can be missed. This prospective trial aimed to pave the way for a mobile application (app) allowing early diagnosis of pneumonitis. The primary goal was the identification of the optimal cut-off of a score to detect pneumonitis of grade ≥2 after radiotherapy for lung cancer. Based on the severity of symptoms (cough, dyspnea, fever), scoring points were 0−9. Receiver operating characteristic (ROC)-curves were used to describe the sensitivity and specificity. The area under the ROC-curve (AUC) was calculated to judge the accuracy of the score, Youden-index was employed to define the optimal cut-off. Until trial termination, 57 of 98 patients were included. Eight of 42 patients evaluable for the primary endpoint (presence or absence of radiation pneumonitis) experienced pneumonitis. AUC was 0.987 (0.961−1.000). The highest sensitivity was achieved with 0−4 points (100%), followed by 5 points (87.5%), highest specificity with 5−6 points (100%). The highest Youden-index was found for 5 points (87.5%). The rate of patient satisfaction with the symptom-based scoring system was 93.5%. A cut-off of 5 points was identified as optimal to differentiate between pneumonitis and no pneumonitis. Moreover, pneumonitis was significantly associated with an increase of ≥3 points from baseline (p < 0.0001). The scoring system provided excellent accuracy and high patient satisfaction. Important foundations for the development of a mobile application were laid.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Correspondence: ; Tel.: +49-451-500-45400
| | - Elisa M. Werner
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Esther Glatzel
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lubeck, 23562 Lubeck, Germany
| | - Steven E. Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ 85259, USA
| | - Søren S. Tvilsted
- Research Department, Zealand University Hospital, 4600 Køge, Denmark
| | - Stefan Janssen
- Department of Radiation Oncology, University of Lubeck, 23562 Lubeck, Germany
- Medical Practice for Radiotherapy and Radiation Oncology, 30161 Hannover, Germany
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Finck JM, Bohnet S, Auth K, Tangemann-Münstedt I, Drömann D, Franzen KF. Smoking Behavior and Smoking Cessation Because of and during the COVID-19 Pandemic: A Brief Online Survey 12 Months into the Pandemic and during the Second Wave in Europe. Int J Environ Res Public Health 2022; 19:16540. [PMID: 36554420 PMCID: PMC9779274 DOI: 10.3390/ijerph192416540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2022] [Revised: 11/28/2022] [Accepted: 12/05/2022] [Indexed: 06/17/2023]
Abstract
Smoking is considered a major preventable cause of cardiovascular and lung diseases, as well as cancer. During the COVID-19 pandemic, there was extensive discussion about the influence of nicotine use; ultimately, smoking was considered a major risk factor for poor disease progression. Therefore, in April 2021, we conducted an anonymous cross-sectional online survey on smoking and vaping behavior, as well as smoking cessation, in four different countries in Europe (the United Kingdom, Germany, Spain, and Italy). A total of 3605 participants completed a questionnaire on their smoking and vaping behaviors and smoking cessation because of and during the COVID-19 pandemic. Fear of COVID-19 infection, a high percentage of quarantine stays (44.9% Italy and 52.1% Spain), and high infection (75.5% Italy and 52.4% Spain) and death (42% Italy) rates in respondents' personal circles were observed mostly in the surveyed populations of Italy and Spain. Smoking cessation attempts and success were mainly seen in the Italian population and were linked to psychological distress, while the same effects were shown for vaping in Spain. In summary, health anxiety was detected in all cohorts. Despite these findings, smoking as a risk factor for severe outcomes of COVID-19 infection did not lead to a higher rate of smoking cessation attempts.
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Affiliation(s)
- Jule M. Finck
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Sabine Bohnet
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Katharina Auth
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Imke Tangemann-Münstedt
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Daniel Drömann
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Klaas F. Franzen
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
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Kuempers C, Jagomast T, Heidel C, Paulsen FO, Bohnet S, Schierholz S, Dreyer E, Kirfel J, Perner S. CDK7 is a prognostic biomarker for non-small cell lung cancer. Front Oncol 2022; 12:927140. [PMID: 36212402 PMCID: PMC9540232 DOI: 10.3389/fonc.2022.927140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 09/02/2022] [Indexed: 11/16/2022] Open
Abstract
Aim Non-small cell lung cancer (NSCLC) remains the leading cause of cancer-related death globally despite promising progress of personalized therapy approaches. Cyclin-dependent kinase 7 (CDK7) is a kinase involved in transcription, overexpressed in a broad spectrum of cancer types and found to be associated with an unfavourable prognosis. In this study, we aimed to investigate the protein expression of CDK7 in a large cohort of NSCLC incorporating adenocarcinomas (adNSCLC) and squamous cell carcinomas (sqNSCLC) and to correlate its expression with clinicopathological data. Methods We performed immunohistochemical staining of CDK7 on our cohort of NSCLC including 258 adNSCLC and 101 sqNSCLC and measured protein expression via a semi-automated read out. According to the median value of CDK7 the cohort was stratified in a CDK7 high and low expressing group, respectively, and results were correlated with clinico-pathological data. Results CDK7 was significantly higher expressed in sqNSCLC than in adNSCLC. In the group of sqNSCLC, CDK7 expression was significantly higher in sqNSCLC with lymph node metastases than in sqNSCLC with N0 stage. We found a significantly worse overall survival and disease-free survival for patients with CDK7 high expressing NSCLC. Conclusion Since a high CDK7 expression seems to be linked with a poor prognosis it might serve as a promising novel prognostic biomarker and its assessment could be implied in future routine diagnostic workup of NSCLC samples. Considering that CDK7 inhibitors are currently tested in several trials for advanced solid malignancies, it may also be a new target for future anti-cancer therapy.
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Affiliation(s)
- Christiane Kuempers
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
- *Correspondence: Christiane Kuempers,
| | - Tobias Jagomast
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Carsten Heidel
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
- Department of Surgery, Schoen Klinik Neustadt, Holstein, Germany
| | - Finn-Ole Paulsen
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
- Department of Oncology, Hematology and Bone Marrow Transplantation with Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Stefanie Schierholz
- Department of Surgery, Medical University of Schleswig-Holstein, Luebeck, Germany
| | - Eva Dreyer
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Jutta Kirfel
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, University Hospital Schleswig-Holstein, Luebeck, Germany
- Pathology, Research Center Borstel-Leibniz Lung Center, Borstel, Germany
- German Center for Lung Research (DZL) Department Borstel, Borstel, Germany
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Vogel-Claussen J, Lasch F, Bollmann BA, May K, Kuhlmann A, Schmid-Bindert G, Kaaks R, Barkhausen J, Bohnet S, Reck M. Design and Rationale of the HANSE Study: A Holistic German Lung Cancer Screening Trial Using Low-Dose Computed Tomography. ROFO-FORTSCHR RONTG 2022; 194:1333-1345. [PMID: 35917826 DOI: 10.1055/a-1853-8291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
BACKGROUND Despite the high prevalence and mortality of lung cancer and proven effectiveness of low-dose computed tomography (LDCT) to reduce mortality, Germany still lacks a national screening program. The German Institute for Quality and Efficiency in Health Care (IQWiG) and the Federal Office for Radiation Protection (BfS) both published positive scientific evaluations recommending a quality-controlled national screening program. IQWiG underlined the importance of a clear risk definition, integrated smoking cessation programs, and quality assurance, highlighting the necessity of procedural optimization. METHODS AND OBJECTIVES In the HANSE study, former and current smokers aged 55-79 years are assessed for their lung cancer risk by the NELSON and PLCOM2012 risk scores. 5000 high-risk participants, defined as PLCOM2012 6-year risk ≥ 1.58 % or fulfilling NELSON risk inclusion criteria, will be screened by LDCT at baseline and after 12 months. Lung nodules are analyzed by a modified Lung-RADS 1.1 score of the HANSE study, and values of emphysema and coronary calcium are determined and randomly reported to the participants. 7100 low-risk participants serve as a control. All patients are followed-up for up to 10 years. The sensitivity and specificity of the two risk assessments and LDCT screening, effects of the randomized LDCT reporting, efficiency of lung nodule management, and several other factors are assessed to analyze the success and quality of the holistic screening program. CONCLUSION The HANSE study is designed as a holistic lung cancer screening study in northern Germany to answer pressing questions for a successful implementation of an effective German lung cancer screening program. KEY POINTS · HANSE is designed to address pressing questions for the implementation of lung cancer screening in Germany.. · HANSE compares NELSON and PLCOM2012 risk assessments for optimal definition of the high-risk group. . · HANSE integrates cardiac calcium and pulmonary emphysema scoring in a holistic screening approach.. CITATION FORMAT · Vogel-Claussen J, Lasch F, Bollmann B et al. Design and Rationale of the HANSE Study: A Holistic German Lung Cancer Screening Trial Using Low-Dose Computed Tomography. Fortschr Röntgenstr 2022; DOI: 10.1055/a-1853-8291.
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Affiliation(s)
- Jens Vogel-Claussen
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Giessen, Germany
| | - Florian Lasch
- Department of Biostatistics, Hannover Medical School, Hannover, Germany
| | - Benjamin-Alexander Bollmann
- Department of respiratory medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Giessen, Germany
| | - Katharina May
- Department of Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Alexander Kuhlmann
- Working Group Health Economics, Martin Luther University Halle Wittenberg, Halle, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), German Center for Lung Research, Giessen, Germany
| | - Gerald Schmid-Bindert
- Oncology Medical Department, AstraZeneca GmbH, Hamburg, Germany.,Medical Faculty Mannheim, Heidelberg University, Heidelberg, Germany
| | - Rudolf Kaaks
- Translational Lung Research Center Heidelberg (TLRC-H), German Center for Lung Research, Giessen, Germany.,Division of Cancer Epidemiology, German Cancer Research Center, Heidelberg, Germany
| | - Jörg Barkhausen
- Department of Radiology and Nuclear Medicine, University Medical Center Schleswig-Holstein Campus Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University Medical Center Schleswig Holstein Campus Lübeck, Lübeck, Germany.,Airway Research Center North (ARCN), German Center for Lung Research, Giessen, Germany
| | - Martin Reck
- Department of Thoracic Oncology, LungenClinic Grosshansdorf GmbH, Grosshansdorf, Germany.,Airway Research Center North (ARCN), German Center for Lung Research, Giessen, Germany
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11
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Vogel-Claussen J, Lasch F, Bollmann AB, May K, Kuhlmann A, Schmid-Bindert G, Kaaks R, Barkhausen J, Bohnet S, Reck M. HANSE – Ganzheitliche Implementierungsstudie eines norddeutschen interdisziplinären Lungenkrebs Früherkennungs-Programms. ROFO-FORTSCHR RONTG 2022. [DOI: 10.1055/s-0042-1749896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- J Vogel-Claussen
- Medizinische Hochschule Hannover, Institut für Radiologie, Hannover
| | - F Lasch
- European Medicines Agency, Amsterdam
| | - A B Bollmann
- Klinik für Pneumologie, Medizinische Hochschule Hannover, Hannover
| | - K May
- Klinik für Radiologie und Nuklearmedizin, UKSH Campus Lübeck, Lübeck
| | - A Kuhlmann
- Center for Health Economics Research Hannover (CHERH), Hannover
| | | | - R Kaaks
- Department of Cancer Epidemiology, German Cancer research Center (DKFZ), Heidelberg
| | - J Barkhausen
- Klinik für Radiologie und Nuklearmedizin, UKSH Campus Lübeck, Lübeck
| | - S Bohnet
- Medizinische Klinik III, UKSH Campus Lübeck, Lübeck
| | - M Reck
- LungenClinic Grosshansdorf GmbH, Großhansdorf
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12
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Werner EM, Glatzel E, Bohnet S, Schild SE, Rades D. Prognostic Factors of Survival After Radiotherapy for Lung Cancer-The Impact of Smoking Pack Years. In Vivo 2022; 36:1297-1301. [PMID: 35478154 DOI: 10.21873/invivo.12830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Revised: 02/28/2022] [Accepted: 03/01/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM The prognostic role of smoking pack years after thoracic irradiation for lung cancer needs further clarification, since previous studies showed conflicting results. Therefore, this study investigated potential prognostic factors for survival including pack years in 170 lung cancer patients receiving local radiotherapy. PATIENTS AND METHODS Twelve factors were retrospectively evaluated for survival including age, sex, tumor site, histology, primary tumor stage, nodal stage, distant metastasis, radiation dose, upfront surgery or systemic treatment, pulmonary function, and number of pack years. RESULTS On univariate analyses, absence of distant metastasis (p=0.049), radiation dose >56 Gy (p=0.019), and ≤40 pack years (p=0.005) were significantly associated with better survival. In the multivariate analysis, number of pack years (hazard ratio 2.18, 95% confidence interval 1.25-3.82, p=0.006) maintained significance; distant metastasis (p=0.34) and radiation dose (p=0.16) were not significant. CONCLUSION Number of pack years was an independent predictor of survival after thoracic irradiation for lung cancer.
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Affiliation(s)
- Elisa M Werner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Esther Glatzel
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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13
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Glatzel E, Werner EM, Bohnet S, Rades D. A Prognostic Tool to Estimate the Risk of Pneumonitis in Patients Irradiated for Lung Cancer. Anticancer Res 2022; 42:2029-2032. [PMID: 35347025 DOI: 10.21873/anticanres.15683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 02/10/2022] [Accepted: 02/11/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Radiotherapy of lung cancer can lead to pneumonitis. This study aimed to identify risk factors and create a prognostic tool. PATIENTS AND METHODS Sixteen factors were evaluated in 169 patients irradiated for lung cancer including age, sex, lung function, primary tumor/nodal stage, histology, tumor location, surgery, systemic treatment, radiation volume, total dose, mean dose to ipsilateral lung, history of another malignancy, pack years, chronic inflammatory disease, and cardiovascular disease. RESULTS Forty-one patients experienced pneumonitis. Significant associations were found for total doses >56 Gy (p=0.023), mean lung doses >20 Gy (p=0.002) or >13 Gy (p<0.001), and chronic inflammatory disease (p=0.034). Considering mean lung dose and chronic inflammatory disease, scores were 2, 3, 4, or 5 points. Pneumonitis rates were 0% (0/35), 24% (14/58), 32% (21/66), and 60% (6/10) (p=0.001), respectively. CONCLUSION Based on significant risk factors, a prognostic tool was developed that can help estimate the risk of pneumonitis and contribute to personalized follow up of patients.
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Affiliation(s)
- Esther Glatzel
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Elisa M Werner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
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14
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Rades D, Glatzel E, Bohnet S, Schild SE, Werner EM. Estimating the Probability of Not Completing the Intended Course of Thoracic Radiotherapy for Lung Cancer. Anticancer Res 2022; 42:1973-1977. [PMID: 35347017 DOI: 10.21873/anticanres.15675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 02/25/2022] [Accepted: 02/28/2022] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM In some patients with lung cancer scheduled for thoracic radiotherapy (RT), treatment is discontinued before reaching the planned dose. For optimal treatment personalization, a tool estimating whether a patient can complete radiotherapy would be helpful. PATIENTS AND METHODS Eleven pre-RT characteristics were analyzed in 170 patients receiving local RT for lung cancer. Characteristics included age, sex, tumor site, histology, tumor and nodal stage, distant metastasis, surgery, systemic treatment, pulmonary function, and smoking history. RESULTS Age >75 years (p=0.038), distant metastasis (p=0.009), and forced expiratory volume in 1 second <1.2 l (p=0.038) were significantly associated with discontinuation of RT. A prognostic instrument was developed in 126 patients with complete data regarding these characteristics. It included three groups (0, 1, and 2-3 points) with non-completion rates of 33.3%, 55.0% and 75.0% (p=0.004). CONCLUSION This new instrument can help estimating the probability that lung cancer patients assigned to local RT cannot complete the planned course of RT.
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Affiliation(s)
- Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany;
| | - Esther Glatzel
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Steven E Schild
- Department of Radiation Oncology, Mayo Clinic, Scottsdale, AZ, U.S.A
| | - Elisa M Werner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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15
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Auth K, Bohnet S, Borck C, Drömann D, Franzen KF. Synonyms and Symptoms of COVID-19 and Individual and Official Actions against the Disease-A Brief Online Survey 6 Months into the Pandemic and on the Threshold of the Second Wave in Germany. Int J Environ Res Public Health 2021; 19:169. [PMID: 35010429 PMCID: PMC8750519 DOI: 10.3390/ijerph19010169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/17/2021] [Accepted: 12/18/2021] [Indexed: 06/14/2023]
Abstract
To control the ongoing global pandemic due to SARS-CoV-2, we need to influence people's behavior. To do so, we require information on people's knowledge and perception of the disease and their opinions about the importance of containment measures. Therefore, in August 2020, we conducted an anonymous cross-sectional online survey on these topics in 913 participants in Germany. Participants completed a questionnaire on various synonyms and symptoms of corona virus and specified the importance they attributed to individual and regulatory measures. The virus was linked more closely with most synonyms and the discovery in China than with the places of the first larger European outbreaks. General (cold-like) symptoms, such as "cough" and "fever," were more widely known than COVID-19-specific ones, e.g., "loss of taste and smell." The widely promoted individual measures "distancing," "hygiene," and "(facial) mask wearing" were rated as highly important, as were the corresponding official measures, e.g., the "distancing rule" and "mask mandate." However, the "corona warning app" and a "vaccine mandate" were rated as less important. A subgroup analysis showed broad agreement between the subgroups on nearly all issues. In conclusion, the survey provided information about the German population's perception and knowledge of the coronavirus five months into the pandemic; however, participants were younger and more educated than a representative sample. To learn from the beginning and still ongoing pandemic and develop concepts for the future, we need more conclusive studies, especially on the acceptance of further specified lockdowns, the population's willingness to be vaccinated, and the influence of misinformation on public opinion.
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Affiliation(s)
- Katharina Auth
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany; (K.A.); (S.B.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Sabine Bohnet
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany; (K.A.); (S.B.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Cornelius Borck
- Institute for History of Medicine and Science Studies, University of Lübeck, 23562 Luebeck, Germany;
| | - Daniel Drömann
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany; (K.A.); (S.B.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
| | - Klaas F. Franzen
- Medical Clinic III, Campus Lübeck, University Hospital Schleswig-Holstein, 23562 Luebeck, Germany; (K.A.); (S.B.); (D.D.)
- Airway Research Center North, Member of the German Center for Lung Research (DZL), 22927 Großhansdorf, Germany
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16
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Kuempers C, Jagomast T, Krupar R, Paulsen FO, Heidel C, Ribbat-Idel J, Idel C, Märkl B, Anlauf M, Berezowska S, Tiemann M, Bösmüller H, Fend F, Kalsdorf B, Bohnet S, Dreyer E, Sailer V, Kirfel J, Perner S. Delta-Like Protein 3 Expression in Paired Chemonaive and Chemorelapsed Small Cell Lung Cancer Samples. Front Med (Lausanne) 2021; 8:734901. [PMID: 34692726 PMCID: PMC8531433 DOI: 10.3389/fmed.2021.734901] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 08/23/2021] [Indexed: 01/22/2023] Open
Abstract
Rovalpituzumab tesirine (Rova-T), an antibody-drug conjugate directed against Delta-like protein 3 (DLL3), is under development for patients with small cell lung cancer (SCLC). DLL3 is expressed on the majority of SCLC samples. Because SCLC is rarely biopsied in the course of disease, data regarding DLL3 expression in relapses is not available. The aim of this study was to investigate the expression of DLL3 in chemorelapsed (but untreated with Rova-T) SCLC samples and compare the results with chemonaive counterparts. Two evaluation methods to assess DLL3 expression were explored. Additionally, we assessed if DLL3 expression of chemorelapsed and/or chemonaive samples has prognostic impact and if it correlates with other clinicopathological data. The study included 30 paired SCLC samples, which were stained with an anti DLL3 antibody. DLL3 expression was assessed using tumor proportion score (TPS) and H-score and was categorized as DLL3 low (TPS < 50%, H-score ≤ 150) and DLL3 high (TPS ≥ 50%, H-score > 150). Expression data were correlated with clinicopathological characteristics. Kaplan–Meier curves were used to illustrate overall survival (OS) depending on DLL3 expression in chemonaive and chemorelapsed samples, respectively, and depending on dynamics of expression during course of therapy. DLL3 was expressed in 86.6% chemonaive and 80% chemorelapsed SCLC samples without significant differences between the two groups. However, the extent of expression varied in a substantial proportion of pairs (36.6% with TPS, 43.3% with H-score), defined as a shift from low to high or high to low expression. TPS and H-score provided comparable results. There were no profound correlations with clinicopathological data. Survival analysis revealed a trend toward a more favorable OS in DLL low-expressing chemonaive SCLC (p = 0.57) and, in turn, in DLL3 high-expressing chemorelapsed SCLC (p = 0.42) as well as in SCLC demonstrating a shift from low to high expression (p = 0.56) without being statistically significant. This is the first study to investigate DLL3 expression in a large cohort of rare paired chemonaive-chemorelapsed SCLC specimens. Comparative analysis revealed that DLL3 expression was not stable during the course of therapy, suggesting therapy-based alterations. Unlike in chemonaive samples, a high DLL3 expression in chemorelapsed samples indicated a trend for a more favorable prognosis. Our results highlight the importance to investigate DLL3 in latest chemorelapsed SCLC tumor tissue.
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Affiliation(s)
- Christiane Kuempers
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Tobias Jagomast
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Rosemarie Krupar
- Pathology, Research Center Borstel-Leibniz Lung Center, Borstel, Germany
| | - Finn-Ole Paulsen
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.,Department of Oncology, Hematology and Bone Marrow Transplantation With Division of Pneumology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Carsten Heidel
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Julika Ribbat-Idel
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Christian Idel
- Department of Otorhinolaryngology, Luebeck, University of Luebeck and University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Bruno Märkl
- Medical Faculty, General Pathology and Molecular Diagnostics, University Augsburg, Augsburg, Germany
| | - Martin Anlauf
- Institute of Pathology, Cytology and Molecular Pathology Limburg, Limburg, Germany
| | - Sabina Berezowska
- Department of Laboratory Medicine and Pathology, Institute of Pathology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.,Institute of Pathology, University of Bern, Bern, Switzerland
| | | | - Hans Bösmüller
- Institute of Pathology and Neuropathology University Hospital Tuebingen, Tuebingen, Germany
| | - Falko Fend
- Institute of Pathology and Neuropathology University Hospital Tuebingen, Tuebingen, Germany
| | - Barbara Kalsdorf
- Medical Clinic, Research Center Borstel-Leibniz Lung Center, Borstel, Germany
| | - Sabine Bohnet
- Department of Pulmonology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Eva Dreyer
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Verena Sailer
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Jutta Kirfel
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany
| | - Sven Perner
- Institute of Pathology, Luebeck, University Hospital Schleswig-Holstein, Luebeck, Germany.,Pathology, Research Center Borstel-Leibniz Lung Center, Borstel, Germany.,Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL), Borstel, Germany
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17
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Arnold S, Deja M, Nitschke M, Bohnet S, Wallis S, Humrich JY, Riemekasten G, Steinhoff J, Lamprecht P. Extracorporeal membrane oxygenation in ANCA-associated vasculitis. Autoimmun Rev 2020; 20:102702. [PMID: 33188916 DOI: 10.1016/j.autrev.2020.102702] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Accepted: 10/19/2020] [Indexed: 11/30/2022]
Affiliation(s)
- Sabrina Arnold
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Maria Deja
- Department of Anaesthesiology and Intensive Care, University of Lübeck, Lübeck, Germany
| | - Martin Nitschke
- Department of Nephrology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Sönke Wallis
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Jens Y Humrich
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | - Gabriela Riemekasten
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany
| | | | - Peter Lamprecht
- Department of Rheumatology and Clinical Immunology, University of Lübeck, Lübeck, Germany.
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18
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Marschner N, Zacharias S, Lordick F, Hegewisch-Becker S, Martens U, Welt A, Hagen V, Gleiber W, Bohnet S, Kruggel L, Dille S, Nusch A, Dörfel S, Decker T, Jänicke M. Association of Disease Progression With Health-Related Quality of Life Among Adults With Breast, Lung, Pancreatic, and Colorectal Cancer. JAMA Netw Open 2020; 3:e200643. [PMID: 32154886 PMCID: PMC7064873 DOI: 10.1001/jamanetworkopen.2020.0643] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
IMPORTANCE Mortality, morbidity, and health-related quality of life (HRQoL) are patient-relevant end points generally considered in the early benefit assessments of new cancer treatments. Progression-related end points, such as time to progression or progression-free survival, are not included, although patients and physicians testify to the detrimental association of disease progression with HRQoL. OBJECTIVE To examine the association of disease progression and HRQoL in 4 prevalent solid-cancer entities in routine clinical practice. DESIGN, SETTING, AND PARTICIPANTS This cohort study evaluated data from 4 prospective, nonintervention, multicenter registries collected between 2011 and 2018 in 203 centers in Germany. Patients' HRQoL was assessed regularly for up to 5 years. The change in HRQoL scores after disease progression was examined with linear mixed models, adjusting for demographic and clinical covariates. Patients with metastatic breast, pancreatic, lung, and colorectal cancer were recruited at the start of systemic first-line treatment. Data analysis was performed from February 2019 to April 2019. EXPOSURES All patients received systemic, palliative first-line treatment according to their physician's choice. MAIN OUTCOMES AND MEASURES The primary outcome was deterioration of HRQoL associated with disease progression, as measured by 4 validated questionnaires: Functional Assessment of Cancer Therapy-General version 4, European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, European Organization for Research and Treatment of Cancer QLQ-C15-PAL version 1, and Hospital Anxiety and Depression Scale. RESULTS More than 8000 questionnaires from 2314 patients with 2562 documented disease progressions were analyzed. In total, 464 patients had breast cancer (464 [100.0%] female; median [range] age, 61.6 [26.4-90.1] years), 807 patients had pancreatic cancer (352 [43.6%] female; median [range] age, 70.0 [39.0-93.0] years), 341 patients had lung cancer (118 [34.6%] female; median [range] age, 65.9 [28.4-88.2] years), and 702 patients had colorectal cancer (248 [35.3%] female; median [range] age, 66.9 [26.9-92.1] years). The first disease progression was associated with a statistically significant worsening of 37 of 45 HRQoL scales; for 17 of these scales, the worsening was clinically meaningful. Scale scores for appetite loss (pancreatic cancer, 10.2 points [95% CI, 6.8-13.5 points]; lung cancer, 10.8 points [95% CI, 5.4-16.2 points]; colorectal cancer, 8.8 points [95% CI, 5.5-12.2]; all P < .001), physical functioning (pancreatic cancer, 6.2 points [95% CI, 3.8-8.5 points]; lung cancer, 8.4 points [95% CI, 5.4-11.5 points]; colorectal cancer, 5.0 points [95% CI, 3.0-7.0 points]; all P < .001), and fatigue (pancreatic cancer, 5.5 points [95% CI, 3.0-7.9 points]; lung cancer, 7.7 points [95% CI, 4.3-11.1]; colorectal cancer, 4.5 points [95% CI, 2.1-6.9 points]; all P < .001) were most affected, irrespective of the type of cancer. The association with global HRQoL was most pronounced in lung cancer (6.7 points [95% CI, 3.5-9.9 points]; P < .001) and pancreatic cancer (5.4 points [95% CI, 3.3-7.5 points]; P < .001) and less in colorectal cancer (3.5 points [95% CI, 1.3-5.7 points]; P = .002) and breast cancer (2.4 points [95% CI, 1.0-3.9 points]; P = .001). The second progression was associated with an even larger decrease in HRQoL. CONCLUSIONS AND RELEVANCE These findings suggest that disease progression is associated with a deterioration in HRQoL among patients with metastatic breast, pancreatic, lung, and colorectal cancer. This evidence highlights the importance of progression-related end points, such as time to progression and progression-free survival, as additional patient-relevant end points when evaluating the benefit of new treatments for patients with metastatic cancer.
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Affiliation(s)
- Norbert Marschner
- Praxis für interdisziplinäre Onkologie und Hämatologie, Freiburg, Germany
| | - Stefan Zacharias
- Kompetenzzentrum für klinische Studien Bremen, Universität Bremen, Bremen, Germany
- Biostatistics, iOMEDICO, Freiburg, Germany
| | - Florian Lordick
- University Cancer Center Leipzig, Leipzig University Medical Center, Leipzig, Germany
| | | | - Uwe Martens
- Klinik für Innere Medizin III, SLK Kliniken Heilbronn, Heilbronn, Germany
| | - Anja Welt
- Innere Klinik Tumorforschung, Universitätsklinikum Essen, Essen, Germany
| | - Volker Hagen
- Klinik für Innere Medizin II, OnkoZentrum, St.-Johannes-Hospital, Dortmund, Germany
| | - Wolfgang Gleiber
- Universitätsklinikum Frankfurt Medizinische Klinik I, Schwerpunkt Pneumologie/Allergologie, Frankfurt, Germany
| | - Sabine Bohnet
- Med. Klinik III, Pneumologie, Universitätsklinikum Schleswig-Holstein, Lübeck, Germany
| | - Lisa Kruggel
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
| | | | - Arnd Nusch
- Praxis für Hämatologie und internistische Onkologie, Ratingen, Germany
| | | | - Thomas Decker
- Studienzentrum Onkologie Ravensburg, Ravensburg, Germany
| | - Martina Jänicke
- Clinical Epidemiology and Health Economics, iOMEDICO, Freiburg, Germany
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Werner EM, Eggert MC, Bohnet S, Rades D. Prevalence and Characteristics of Pneumonitis Following Irradiation of Breast Cancer. Anticancer Res 2019; 39:6355-6358. [PMID: 31704867 DOI: 10.21873/anticanres.13847] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Revised: 09/30/2019] [Accepted: 10/01/2019] [Indexed: 11/10/2022]
Abstract
BACKGROUND/AIM Pneumonitis is a serious complication after radiotherapy of breast cancer. This study aimed to identify its prevalence and potential risk factors. PATIENTS AND METHODS A total of 606 patients irradiated following breast-conserving surgery or mastectomy were retrospectively analyzed. In patients developing pneumonitis, radiation and clinical parameters were investigated to identify potential risk factors. RESULTS Eleven patients (1.8%) developed a pneumonitis grade ≥2. Mean doses to the ipsilateral lung were >7 Gy in 5 patients (45%). Of the other patients, 5 had a chronic inflammatory disease. Six patients (55%) had another malignancy (4 previous contralateral breast cancers, 1 previous ovarian and thyroid cancer, 1 synchronous carcinoma-in-situ (pTis) at the contralateral breast). Five patients (45%) received chemotherapy including taxanes and 4 patients (36%) received trastuzumab. CONCLUSION The prevalence of pneumonitis was 1.8%. Potential risk factors included mean radiation dose to ipsilateral lung >7 Gy, systemic treatment with taxanes or trastuzumab, chronic inflammatory disease and history of another malignancy.
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Affiliation(s)
- Elisa M Werner
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Marie C Eggert
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
| | - Sabine Bohnet
- Department of Pulmonology, University of Lübeck, Lübeck, Germany
| | - Dirk Rades
- Department of Radiation Oncology, University of Lübeck, Lübeck, Germany
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Reungwetwattana T, Nakagawa K, Cho BC, Cobo M, Cho EK, Bertolini A, Bohnet S, Zhou C, Lee KH, Nogami N, Okamoto I, Leighl N, Hodge R, McKeown A, Brown AP, Rukazenkov Y, Ramalingam SS, Vansteenkiste J. CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. J Clin Oncol 2018; 36:JCO2018783118. [PMID: 30153097 DOI: 10.1200/jco.2018.78.3118] [Citation(s) in RCA: 437] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
Purpose We report CNS efficacy of osimertinib versus standard epidermal growth factor receptor ( EGFR) tyrosine kinase inhibitors (TKIs) in patients with untreated EGFR-mutated advanced non-small-cell lung cancer from the phase III FLAURA study. Patients and Methods Patients (N = 556) were randomly assigned to osimertinib or standard EGFR-TKIs (gefitinib or erlotinib); brain scans were not mandated unless clinically indicated. Patients with asymptomatic or stable CNS metastases were included. In patients with symptomatic CNS metastases, neurologic status was required to be stable for ≥ 2 weeks after completion of definitive therapy and corticosteroids. A preplanned subgroup analysis with CNS progression-free survival as primary objective was conducted in patients with measurable and/or nonmeasurable CNS lesions on baseline brain scan by blinded independent central neuroradiologic review. The CNS evaluable-for-response set included patients with ≥ one measurable CNS lesion. Results Of 200 patients with available brain scans at baseline, 128 (osimertinib, n = 61; standard EGFR-TKIs, n = 67) had measurable and/or nonmeasurable CNS lesions, including 41 patients (osimertinib, n = 22; standard EGFR-TKIs, n = 19) with ≥ one measurable CNS lesion. Median CNS progression-free survival in patients with measurable and/or nonmeasurable CNS lesions was not reached with osimertinib (95% CI, 16.5 months to not calculable) and 13.9 months (95% CI, 8.3 months to not calculable) with standard EGFR-TKIs (hazard ratio, 0.48; 95% CI, 0.26 to 0.86; P = .014 [nominally statistically significant]). CNS objective response rates were 91% and 68% in patients with ≥ one measurable CNS lesion (odds ratio, 4.6; 95% CI, 0.9 to 34.9; P = .066) and 66% and 43% in patients with measurable and/or nonmeasurable CNS lesions (odds ratio, 2.5; 95% CI, 1.2 to 5.2; P = .011) treated with osimertinib and standard EGFR-TKIs, respectively. Probability of experiencing a CNS progression event was consistently lower with osimertinib versus standard EGFR-TKIs. Conclusion Osimertinib has CNS efficacy in patients with untreated EGFR-mutated non-small-cell lung cancer. These results suggest a reduced risk of CNS progression with osimertinib versus standard EGFR-TKIs.
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Affiliation(s)
- Thanyanan Reungwetwattana
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kazuhiko Nakagawa
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Byoung Chul Cho
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Manuel Cobo
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Eun Kyung Cho
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alessandro Bertolini
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sabine Bohnet
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Caicun Zhou
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ki Hyeong Lee
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Naoyuki Nogami
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Isamu Okamoto
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Natasha Leighl
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rachel Hodge
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Astrid McKeown
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Andrew P Brown
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Yuri Rukazenkov
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Suresh S Ramalingam
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Johan Vansteenkiste
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
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Reungwetwattana T, Nakagawa K, Cho BC, Cobo M, Cho EK, Bertolini A, Bohnet S, Zhou C, Lee KH, Nogami N, Okamoto I, Leighl N, Hodge R, McKeown A, Brown AP, Rukazenkov Y, Ramalingam SS, Vansteenkiste J. CNS Response to Osimertinib Versus Standard Epidermal Growth Factor Receptor Tyrosine Kinase Inhibitors in Patients With Untreated EGFR-Mutated Advanced Non-Small-Cell Lung Cancer. J Clin Oncol 2018. [PMID: 30153097 DOI: 10.1200/jco.2018.78.3118:jco2018783118] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Purpose We report CNS efficacy of osimertinib versus standard epidermal growth factor receptor ( EGFR) tyrosine kinase inhibitors (TKIs) in patients with untreated EGFR-mutated advanced non-small-cell lung cancer from the phase III FLAURA study. Patients and Methods Patients (N = 556) were randomly assigned to osimertinib or standard EGFR-TKIs (gefitinib or erlotinib); brain scans were not mandated unless clinically indicated. Patients with asymptomatic or stable CNS metastases were included. In patients with symptomatic CNS metastases, neurologic status was required to be stable for ≥ 2 weeks after completion of definitive therapy and corticosteroids. A preplanned subgroup analysis with CNS progression-free survival as primary objective was conducted in patients with measurable and/or nonmeasurable CNS lesions on baseline brain scan by blinded independent central neuroradiologic review. The CNS evaluable-for-response set included patients with ≥ one measurable CNS lesion. Results Of 200 patients with available brain scans at baseline, 128 (osimertinib, n = 61; standard EGFR-TKIs, n = 67) had measurable and/or nonmeasurable CNS lesions, including 41 patients (osimertinib, n = 22; standard EGFR-TKIs, n = 19) with ≥ one measurable CNS lesion. Median CNS progression-free survival in patients with measurable and/or nonmeasurable CNS lesions was not reached with osimertinib (95% CI, 16.5 months to not calculable) and 13.9 months (95% CI, 8.3 months to not calculable) with standard EGFR-TKIs (hazard ratio, 0.48; 95% CI, 0.26 to 0.86; P = .014 [nominally statistically significant]). CNS objective response rates were 91% and 68% in patients with ≥ one measurable CNS lesion (odds ratio, 4.6; 95% CI, 0.9 to 34.9; P = .066) and 66% and 43% in patients with measurable and/or nonmeasurable CNS lesions (odds ratio, 2.5; 95% CI, 1.2 to 5.2; P = .011) treated with osimertinib and standard EGFR-TKIs, respectively. Probability of experiencing a CNS progression event was consistently lower with osimertinib versus standard EGFR-TKIs. Conclusion Osimertinib has CNS efficacy in patients with untreated EGFR-mutated non-small-cell lung cancer. These results suggest a reduced risk of CNS progression with osimertinib versus standard EGFR-TKIs.
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Affiliation(s)
- Thanyanan Reungwetwattana
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Kazuhiko Nakagawa
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Byoung Chul Cho
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Manuel Cobo
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Eun Kyung Cho
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Alessandro Bertolini
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Sabine Bohnet
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Caicun Zhou
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Ki Hyeong Lee
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Naoyuki Nogami
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Isamu Okamoto
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Natasha Leighl
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Rachel Hodge
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Astrid McKeown
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Andrew P Brown
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Yuri Rukazenkov
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Suresh S Ramalingam
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
| | - Johan Vansteenkiste
- Thanyanan Reungwetwattana, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand; Kazuhiko Nakagawa, Kindai University School of Medicine, Osaka; Naoyuki Nogami, National Hospital Organization Shikoku Cancer Center, Matsuyama; Isamu Okamoto, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan; Byoung Chul Cho, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul; Eun Kyung Cho, Gachon University Gil Medical Center, Incheon; Ki Hyeong Lee, Chungbuk National University Hospital, Cheong-ju, Republic of Korea; Manuel Cobo, Institute of Biomedical Research in Málaga, Málaga University Hospital Regional, Málaga, Spain; Alessandro Bertolini, Hospital of Sondrio, Sondrio, Italy; Sabine Bohnet, Universitätsklinik Schleswig-Holstein, Lübeck, Germany; Caicun Zhou, Pulmonary Hospital of Tongji University, Shanghai, People's Republic of China; Natasha Leighl, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Rachel Hodge, Astrid McKeown, Andrew P. Brown, and Yuri Rukazenkov, AstraZeneca, Cambridge, United Kingdom; Suresh S. Ramalingam, Winship Cancer Institute, Emory University, Atlanta, GA; and Johan Vansteenkiste, University Hospital, Katholieke Universiteit Leuven, Leuven, Belgium
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Rolfes V, Idel C, Pries R, Plötze-Martin K, Habermann J, Gemoll T, Bohnet S, Latz E, Ribbat-Idel J, Franklin BS, Wollenberg B. PD-L1 is expressed on human platelets and is affected by immune checkpoint therapy. Oncotarget 2018; 9:27460-27470. [PMID: 29937998 PMCID: PMC6007942 DOI: 10.18632/oncotarget.25446] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 04/28/2018] [Indexed: 12/30/2022] Open
Abstract
Cancer immunotherapy has been revolutionised by drugs that enhance the ability of the immune system to detect and fight tumors. Immune checkpoint therapies that target the programmed death-1 receptor (PD-1), or its ligand (PD-L1) have shown unprecedented rates of durable clinical responses in patients with various cancer types. However, there is still a large fraction of patients that do not respond to checkpoint inhibitors, and the challenge remains to find cellular and molecular cues that could predict which patients would benefit from these therapies. Using a series of qualitative and quantitative methods we show here that PBMCs and platelets from smokers and patients with head and neck squamous cell carcinoma (HNSCC) or lung cancer express and up-regulate PD-L1 independently of tumor stage. Furthermore, treatment with Atezolizumab, a fully humanised monoclonal antibody against PD-L1, in 4 patients with lung cancer caused a decrease in PD-L1 expression in platelets, which was restored over 20 days. Altogether, our findings reveal the expression of the main therapeutic target in current checkpoint therapies in human platelets and highlight their potential as biomarkers to predict successful therapeutic outcomes.
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Affiliation(s)
- Verena Rolfes
- Institute of Innate Immunity, University Hospital, University of Bonn, Bonn, Germany
| | - Christian Idel
- University Hospital Schleswig Holstein, Campus Lübeck, Clinic for Otorhinolaryngology – Head and Neck Surgery, Luebeck, Germany
| | - Ralph Pries
- University Hospital Schleswig Holstein, Campus Lübeck, Clinic for Otorhinolaryngology – Head and Neck Surgery, Luebeck, Germany
| | - Kirstin Plötze-Martin
- University Hospital Schleswig Holstein, Campus Lübeck, Clinic for Otorhinolaryngology – Head and Neck Surgery, Luebeck, Germany
| | - Jens Habermann
- University Hospital Schleswig Holstein, Campus Lübeck, Section for Translational Oncology and Biobanking, Clinic for Surgery, Luebeck, Germany
| | - Timo Gemoll
- University Hospital Schleswig Holstein, Campus Lübeck, Section for Translational Oncology and Biobanking, Clinic for Surgery, Luebeck, Germany
| | - Sabine Bohnet
- University Hospital Schleswig Holstein, Campus Lübeck, Clinic for Pulmonary Medicine, Luebeck, Germany
| | - Eicke Latz
- Institute of Innate Immunity, University Hospital, University of Bonn, Bonn, Germany
- Department of Infectious Diseases and Immunology, University of Massachusetts Medical School, Worcester, MA, USA
- German Center for Neurodegenerative Diseases, Bonn, Germany
| | - Julika Ribbat-Idel
- Department of Pathology, University Medical Center Schleswig-Holstein, Luebeck, Germany
| | - Bernardo S. Franklin
- Institute of Innate Immunity, University Hospital, University of Bonn, Bonn, Germany
| | - Barbara Wollenberg
- University Hospital Schleswig Holstein, Campus Lübeck, Clinic for Otorhinolaryngology – Head and Neck Surgery, Luebeck, Germany
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Bischoff HG, Rückert A, Reinmuth N, Grohé C, Bohnet S, Meyer zum Büschenfelde C. Osimertinib (OSI) vs. Standardtherapie (SoC) EGFR-TKI als Erstlinientherapie bei Patienten mit EGFRm fortgeschrittenem NSCLC. Pneumologie 2018. [DOI: 10.1055/s-0037-1619268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- HG Bischoff
- University Hospital Heidelberg; Thoraxklinik Heidelberg
| | - A Rückert
- Onkologie, Hämatologie, Immunologie, Infektiologie und Palliativmedizin, Klinik für Innere Medizin II, Schwarzwald-Baar-Klinikum, Villingen-Schwenningen
| | - N Reinmuth
- Onkologie der Klinik für Pneumologie, Asklepios Fachkliniken Gauting
| | - C Grohé
- Klinik für Pneumologie, Evangelische Lungenklinik Berlin
| | - S Bohnet
- Medizinische Klinik III, UKSH Lübeck
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Vansteenkiste J, Reungwetwattana T, Nakagawa K, Cho B, Dols M, Cho E, Bertolini A, Bohnet S, Zhou C, Lee K, Nogami N, Okamoto I, Leighl N, Hodge R, McKeown A, Brown A, Rukazenkov Y, Ramalingam S. CNS response to osimertinib vs standard of care (SoC) EGFR-TKI as first-line therapy in patients (pts) with EGFR-TKI sensitising mutation (EGFRm)-positive advanced non-small cell lung cancer (NSCLC): Data from the FLAURA study. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx782] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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25
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Kopeleva O, Parschke P, Wallis S, Bohnet S, Drömann D, Dalhoff K. Retentionspneumonie bei Lungenkarzinom – Inzidenz und prädiktiver Wert der bronchoskopischen Infektionsdiagnostik. Pneumologie 2015. [DOI: 10.1055/s-0035-1544613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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26
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Deppermann KM, Hoeffken G, Wuerflein D, Feurer M, Rittmeyer A, Bohnet S, Nagel S, Schumann C, Huber RM, Gleiber W, Müller E, Feldmeyer F, Wolf M, Tessen HW, Hutzschenreuther U, Schulz C, Stern S, Pott D, Schulte C, Heigner D. Systemic treatment of elderly patients with NSCLC: Results of a German prospective observational study. J Clin Oncol 2014. [DOI: 10.1200/jco.2014.32.15_suppl.e19052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Sylke Nagel
- Hospital Martha-Maria Halle-Doelau, Halle, Germany
| | | | | | | | | | | | - Martin Wolf
- Department of Internal Medicine, Division of Haematology and Oncology, Klinikum Kassel, Kassel, Germany
| | | | | | | | | | - Dirk Pott
- Praxis Haemato-Oncology, Bottrop, Germany
| | - Clemens Schulte
- GEFOS Gesellschaft f. Onkologische Studien Dortmund mbH, Dortmund, Germany
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27
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Schuette WHW, Gröschel A, Sebastian M, Andreas S, Müller T, Schneller F, Guetz S, Eschbach C, Bohnet S, Leschinger MI, Reck M. A randomized phase II study of pemetrexed in combination with cisplatin or carboplatin as first-line therapy for patients with locally advanced or metastatic non-small-cell lung cancer. Clin Lung Cancer 2013; 14:215-23. [PMID: 23332288 DOI: 10.1016/j.cllc.2012.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 09/28/2012] [Accepted: 10/08/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Pemetrexed plus cisplatin was approved for first-line treatment of non-small-cell lung cancer (NSCLC) in patients with nonsquamous histology after initiation of this study. This phase II study evaluated pemetrexed plus cisplatin and pemetrexed plus carboplatin as first-line treatments for stage IIIB/IV NSCLC. PATIENTS AND METHODS The patients were randomized (1:1) to 2 parallel arms: pemetrexed (500 mg/m(2)) plus cisplatin (75 mg/m(2)) or pemetrexed (500 mg/m(2)) plus carboplatin (area under the curve 6) day 1 every 3 weeks (maximum, 6 cycles). Progression-free survival (PFS) was the primary objective; secondary objectives included overall survival (OS), 1-year survival, and safety. RESULTS Sixty-five patients were randomized to each treatment arm. The patients treated with pemetrexed plus cisplatin had a median age of 64 years and were predominantly men (42 [64.6%]) with nonsquamous histology (53 [81.5%]), stage IV (61 [92.4%]) disease, and a performance status of 0 (40 [61.5%]). Median PFS was 6.0 months, 6-month PFS rate was 50.5%, median OS was 11.7 months, and 1-year survival rate was 47.5%. Drug-related grade 3/4 toxicities included neutropenia (11 [16.9%]), anemia (5 [7.7%]), thrombocytopenia (2 [3.1%]), and nausea (3 [4.6%]). Patients treated with pemetrexed plus carboplatin had a median age of 63 years, were predominantly men (46 [70.8%]) with nonsquamous histology (52 [80.0%]), stage IV (58 [86.6%]) disease, and a performance status of 0 (45 [69.2%]). The median PFS was 4.7 months, the 6-month PFS rate was 34.9%, median OS was 8.9 months, and 1-year survival rate was 39.2%. Drug-related grade 3/4 toxicities included neutropenia (17 [26.2%]), thrombocytopenia (11 [16.9%]), anemia (7 [10.8%]), and nausea (5 [7.7%]). CONCLUSIONS Both the pemetrexed plus cisplatin and pemetrexed plus carboplatin arms met their primary endpoints and demonstrated efficacy and tolerability as first-line therapy in patients with advanced NSCLC. http://ClinicalTrials.gov: NCT00402051.
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Affiliation(s)
- Wolfgang H W Schuette
- Department of Internal Medicine II, Hospital Martha-Maria, Halle-Dölau, Halle, Germany.
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28
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Kenz S, Haas C, Werth S, Bohnet S, Brabant G. High sensitivity to tolvaptan in paraneoplastic syndrome of inappropriate ADH secretion (SIADH). Ann Oncol 2011; 22:2696. [DOI: 10.1093/annonc/mdr431] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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29
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Reck M, Pawel JV, Fischer J, Kortsik C, Bohnet S, Eiff MV, Koester W, Thomas M, Deppermann KM. Erlotinib vs. Carboplatin/Vinorelbin bei älteren Patienten (>70 Jahre) mit fortgeschrittenem nichtkleinzelligem Lungenkarzinom (NSCLC): eine randomisierte Phase II Studie der AIO Arbeitsgruppe Thorakale Onkologie. Pneumologie 2011. [DOI: 10.1055/s-0031-1272245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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30
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Reck M, Bohnet S. [Treatment of small-cell lung cancer]. Internist (Berl) 2011; 52:130, 132-4, 136-7. [PMID: 21240475 DOI: 10.1007/s00108-010-2696-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Treatment of small cell lung cancer (SCLC) is based on the stage of disease. While combination of chemo- and radiotherapy preferably as concomitant chemoradiotherapy represents standard treatment in patients with locally advanced tumors (UICC stage I-III), patients with metastatic disease (stage IV) should be treated with an established platinum based chemotherapy regimen. After chemotherapy and in case of an achieved tumor response treatment should be completed by an adjuvant radiation of the brain in patients with adequate performance status. In patients with a very early stage of disease without involvement of lymph node metastasis a surgical approach in combination with an adjuvant chemotherapy can be discussed. In patients with relapsed tumors second line therapies like the topoisomerase I inhibitor Topotecan have proven efficacy. Up to now neither molecular targeted therapies nor cytotoxic or immunological maintenance strategies have provided any benefit to patients with SCLC.
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Affiliation(s)
- M Reck
- Krankenhaus Grosshansdorf, Zentrum für Pneumologie und Thoraxchirurgie, Grosshansdorf, Deutschland.
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31
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Reck M, Von Pawel J, Fischer JR, Kortsik C, Bohnet S, von Eiff M, Koester W, Thomas M, Schnabel P, Deppermann KM. Erlotinib versus carboplatin/vinorelbine in elderly patients (age 70 or older) with advanced non-small cell lung carcinoma (NSCLC): A randomized phase II study of the German Thoracic Oncology Working Group. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.7565] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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32
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Vansteenkiste JF, Brümmendorf T, Schuette W, Guigay J, Waller CF, Mesia R, Germonpre P, Bohnet S, Vermorken JB. Safety of different regimens of the novel integrin inhibitor cilengitide combined with cetuximab and platinum-based chemotherapies. J Clin Oncol 2010. [DOI: 10.1200/jco.2010.28.15_suppl.e18067] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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33
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Braun J, Dinkelacker C, Bohnet S, Kreft B, Dalhoff K. 1,25-dihydroxycholecalciferol stimulates ICAM-1 expression of human alveolar macrophages in healthy controls and patients with sarcoidosis. Lung 1999; 177:139-49. [PMID: 10192761 DOI: 10.1007/pl00007635] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Synthesis and release of 1,25-dihydroxycholecalciferol (1, 25-(OH)2D2) by alveolar macrophages (AM) have been shown to be increased in granulomatous lung disease. ICAM-1 plays a major part in leukocyte homing to sites of chronic inflammation, which is a crucial step during the inflammatory response. Whether 1,25-(OH)2D2 alters the ICAM-1 expression of AM in humans has not been studied. Bronchoalveolar lavage (BAL) was performed in 12 healthy volunteers, in 13 patients with sarcoidosis (active disease n = 8, inactive disease n = 5), and in 9 patients with chronic bronchitis. AM were incubated with different concentrations of 1,25-(OH)2D2 (10(-11) to 10(-6) M) with and without priming with interferon-gamma (IFN-gamma) and with and without preincubation with 10(-8) M dexamethasone. In addition, the metabolites of vitamin D, 24, 25-dihydroxycholecalciferol and 25-hydroxycholecalciferol, were used. The AM expression of ICAM-1 (cELISA) and the release of tumor necrosis factor-alpha (TNF-alpha) (bioassay) by AM were determined. In healthy volunteers the ICAM-1 expression on AM was significantly and dose-dependently increased by 1,25-(OH)2D2, but not by 24, 25-dihydroxycholecalciferol and 25-hydroxycholecalciferol. Priming with IFN-gamma resulted in an additive effect. Preincubation with dexamethasone inhibited ICAM-1 expression. Addition of 1,25-(OH)2D2 after inhibition by dexamethasone increased ICAM-1 expression significantly. TNF-alpha secretion of AM from healthy volunteers was significantly reduced by 1,25-(OH)2D2. In sarcoidosis patients ICAM-1 expression was significantly higher compared with healthy volunteers. Incubation with 1,25-(OH)2D2 resulted in a further significant increase of ICAM-1 expression. TNF-alpha secretion of AM was increased compared with healthy volunteers. 1,25-(OH)2D2 reduced TNF-alpha secretion; however, this difference was not significant. 1, 25-(OH)2D2 has an immunomodulating effect on human AM both in healthy volunteers and in sarcoidosis patients with enhanced expression of ICAM-1. It may serve as an autocrine mediator in inflammatory lung disease.
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Affiliation(s)
- J Braun
- Department of Medicine II, Medical University of Lübeck, Ratzeburger Allee 160, D-23538 Lübeck, Germany
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34
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Redecke V, Dalhoff K, Bohnet S, Braun J, Maass M. Interaction of Chlamydia pneumoniae and human alveolar macrophages: infection and inflammatory response. Am J Respir Cell Mol Biol 1998; 19:721-7. [PMID: 9806736 DOI: 10.1165/ajrcmb.19.5.3072] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The obligate intracellular pathogen Chlamydia pneumoniae is associated with chronic respiratory, atherosclerotic, and rheumatic disease. The alveolar macrophage (AM) is a potential target cell for the pathogen and may contribute to respiratory immunopathology. We therefore investigated in vitro the interaction between chlamydiae and macrophages with cocultures of C. pneumoniae and AM from 12 healthy volunteers. Inflammatory responses were evaluated through lucigenin-amplified chemiluminescence; secretion of tumor necrosis factor-alpha (TNF-alpha), interleukin-1beta (IL-1beta), and interleukin 8 (IL-8); and expression of intercellular adhesion molecule-1 (ICAM-1) and human leukocyte antigen-DR (HLA-DR). C. pneumoniae readily induced productive infection in the AM. Inclusions containing replicating pathogens could be maintained for up to 120 h. Morphologically similar infection patterns were seen ex vivo in AM collected from six patients with known C. pneumoniae pneumonia. AM responded to the infection with a marked, dose-dependent release of reactive oxygen species, TNF-alpha, IL-1beta, and IL-8. ICAM-1 expression remained unchanged, but HLA-DR was significantly upregulated. Our data indicate that the release of antimicrobial mediators cannot prevent chlamydial infection and replication in AM, but may be involved in amplification of the local inflammatory response in C. pneumoniae pneumonia.
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Affiliation(s)
- V Redecke
- Department of Medicine II and Institute of Medical Microbiology, Medical University of Lübeck, Lübeck, Germany
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35
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Yao C, Bohnet S, Jasmer DP. Host nuclear abnormalities and depletion of nuclear antigens induced in Trichinella spiralis-infected muscle cells by the anthelmintic mebendazole. Mol Biochem Parasitol 1998; 96:1-13. [PMID: 9851602 DOI: 10.1016/s0166-6851(98)00082-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Infection by the parasitic nematode Trichinella spiralis induces cell cycle repositioning (chronic suspension in apparent G2/M) and genetic reprogramming in differentiated mammalian skeletal muscle cells. These changes occur in association with dramatic enlargement of infected host cell nuclei (as large as 17 microm in diameter) and nucleoli. Nuclear antigens (NA) that colocalize with host chromatin have been detected by antibodies to T. spiralis antigens, but the functions of these NA are unresolved. Mebendazole (MBZ) preferentially binds parasite versus host beta-tubulins, is implicated in inhibiting secretion in nematodes and induces cytoplasmic changes in muscle cells infected with T. spiralis. These infected cell changes might be indirect via MBZ inhibition of parasite secretions. This effect would have implications for host/parasite interactions and was evaluated here. MBZ treatment of chronically infected mice caused: (1) a significant deformation of host nuclei and diminution of nucleoli by 4 and 6 days of treatment (dot), respectively; (2) a reduction of nuclear lamins A/C in infected cell nuclei that was concomitant with nuclear deformation; and (3) significant reductions in total RNA, general protein and acid phosphatase activity levels. These changes were associated with the depletion of NA from host nuclei detected by 4 dot. However, DNA content of infected cell nuclei was not detectably reduced and muscle gene expression was not reactivated. The cellular changes documented are likely to account for previously described cytoplasmic alterations induced by MBZ. Concomitant depletion of NA from infected cell nuclei suggests a role of these products in regulating nuclear functions of host cells.
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Affiliation(s)
- C Yao
- Department of Veterinary Microbiology and Pathology, College of Veterinary Medicine, Washington State University, Pullman 99164-7040, USA
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36
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Bohnet S, Kötschau U, Braun J, Dalhoff K. Role of interleukin-8 in community-acquired pneumonia: relation to microbial load and pulmonary function. Infection 1997; 25:95-100. [PMID: 9108184 PMCID: PMC7101691 DOI: 10.1007/bf02113584] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/1996] [Accepted: 12/16/1996] [Indexed: 02/04/2023]
Abstract
In pneumonia local phagocyte activation is crucial for clearing of pathogenic microorganisms. In this context alveolar macrophage interleukin-8 secretion, phagocyte oxidative response and concentrations of lavage proteins were quantified, including interleukin-8, in 31 patients with pneumonia, 13 age matched patients with peripheral lung consolidation and six healthy volunteers; these findings were related to the impairment of gas exchange and the bacterial load in the alveolar space. Increased interleukin-8 levels were found in bronchoalveolar lavage fluid (BALF) and in alveolar macrophage supernatants from patients with pneumonia (214 ng/10(5) AM +/- 121 vs 71 ng/10(5) AM +/- 35 and 66 ng/10(5) AM +/- 30, p < 0.05). Interleukin-8 release from alveolar macrophages correlated with the upregulated spontaneous luminol enhanced oxidative response of pulmonary phagocytes but not with the neutrophil count in BALF. In pneumonia patients a significant difference was found between patients with 10(4) or more colony forming units (CFU)/ml BALF of one pathogen and patients with less CFU or nonspecific microbiological results (261 ng/10(5) AM +/- 89 vs 179 ng/10(5) AM +/- 81 and 7.5 ng/ml BALF +/- 17 vs 0.44 ng/ml BALF +/- 1, p < 0.05). Further, a negative correlation between interleukin-8 release of alveolar macrophages and the arterial pO2 at the time of BALF could be demonstrated (r = -0.47, p < 0.05). The results demonstrate local cellular activation in community-acquired pneumonia, which is related to the bacterial load in the alveolar space and to impairment of gas exchange. This is consistent with the hypothesis that pulmonary phagocytes play a central role in the pathogenesis of bacterial pneumonia, contributing not only to bacterial clearing but also to local tissue damage.
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Affiliation(s)
- S Bohnet
- Medizinische Klinik II, Medizinische Universität zu Lübeck, Germany
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37
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Abstract
In acquired immune deficiency syndrome (AIDS) patients, alveolar macrophages (AMs) have an increased ability to serve as accessory cells during the generation of an immune response. In addition to soluble mediators, like cytokines, molecules of the major histocompatibility complex (MHC) class II and adhesion molecules, like intercellular adhesion molecule-1 (ICAM-1), play a major role in the regulation of these cellular interactions. Using an enzyme-linked immunosorbent assay (ELISA) technique and immunocytochemical staining, we investigated ICAM-1 and human leucocyte antigen-DR (HLA-DR) expression on AMs from 20 AIDS (HIV+) patients in context with other parameters of macrophage activation, such as tumour necrosis factor-alpha (TNF-alpha) secretion and the release of superoxide anion, comparing the results to a group of healthy volunteers. In addition, we quantified soluble ICAM-1 in the bronchoalveolar lavage fluid (BALF) using a commercially available kit. We found a nearly twofold increase in ICAM-1 expression (0.81 +/- 0.30 (SD) versus 0.42 +/- 0.12 ELISA units (EU) (mean +/- SD)), whilst the number of HLA-DR+ AMs was slightly decreased in AIDS-patients (80 +/- 5 versus 89 +/- 3%). Furthermore, soluble ICAM-1 in the BALF of these patients was significantly increased (41.9 +/- 26.1 versus 19.1 +/- 5.1 ng.ml-1). ICAM-1 levels on AMs in the patient group correlated strongly with the sodium fluoride triggered release of superoxide anion (O2-) but not with the spontaneous secretion of TNF-alpha by AMs.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- S Bohnet
- Dept of Internal Medicine, Medical University of Lübeck, Germany
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38
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Dalhoff K, Bohnet S, Braun J, Kreft B, Wiessmann KJ. Intercellular adhesion molecule 1 (ICAM-1) in the pathogenesis of mononuclear cell alveolitis in pulmonary sarcoidosis. Thorax 1993; 48:1140-4. [PMID: 7905208 PMCID: PMC464902 DOI: 10.1136/thx.48.11.1140] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Alveolitis in pulmonary sarcoidosis is characterised by an accumulation of highly activated macrophages and CD4+ lymphocytes in the alveolar compartment. The role of intercellular adhesion molecule 1 (ICAM-1) expression on alveolar cells has been studied in this context. METHODS Using a sandwich ELISA technique, ICAM-1 expression on alveolar macrophages from 17 consecutive untreated patients with pulmonary sarcoidosis and six healthy normal volunteers was quantified. In addition, parameters of macrophage activation (tumour necrosis factor alpha (TNF alpha) and superoxide anion release) were evaluated. RESULTS Significantly elevated expression could be demonstrated on alveolar macrophages from patients with pulmonary sarcoidosis compared with healthy controls (mean (SD) 0.74 (0.24) ELISA units (EU) v 0.46 (0.12) EU). On subdividing the patients into those with active and those with inactive disease, only the former showed increased ICAM-1 levels on alveolar macrophages (0.82 (0.27) EU) compared with control alveolar macrophages. No differences were detected in serum levels of soluble ICAM-1 between patients and controls. ICAM-1 expression on alveolar macrophages from patients with sarcoidosis correlated with the spontaneous release of TNF alpha but not with the release of the superoxide anion by the activated macrophages. There was no correlation with the percentage of lymphocytes or the absolute number of CD4+ cells in bronchoalveolar lavage fluid. CONCLUSIONS Increased ICAM-1 surface expression on alveolar macrophages reflects disease activity in the pulmonary compartment. Considering the significance of adhesion molecules during antigen presentation and lymphocyte activation, ICAM-1 expression on alveolar macrophages may have an important role in the immune process of pulmonary sarcoidosis.
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Affiliation(s)
- K Dalhoff
- Department of Internal Medicine, Medical University of Lübeck, Germany
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39
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Kreft B, Bohnet S, Carstensen O, Hacker J, Marre R. Differential expression of interleukin-6, intracellular adhesion molecule 1, and major histocompatibility complex class II molecules in renal carcinoma cells stimulated with S fimbriae of uropathogenic Escherichia coli. Infect Immun 1993; 61:3060-3. [PMID: 8099898 PMCID: PMC280959 DOI: 10.1128/iai.61.7.3060-3063.1993] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
The production of interleukin-6, intracellular adhesion molecule 1, and major histocompatibility complex class II molecules by a renal carcinoma cell line (ACHN) in response to S fimbriae of uropathogenic Escherichia coli was studied. S fimbriae adhered to ACHN cells and stimulated the production of interleukin-6 and intercellular adhesion molecule 1 but did not affect major histocompatibility complex class II expression by renal carcinoma cells. Our data demonstrate that S fimbriae of E. coli display immunomodulating properties on kidney-derived epithelial cells.
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Affiliation(s)
- B Kreft
- Klinik für Innere Medizin, Medizinischen Universität zu Lübeck, Germany
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40
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Abstract
The role of the major secretory protein of Legionella pneumophila, a zinc protease, in Legionella infection is not known. Since an important step of the host reaction in Legionnaires' disease is the production of tumor necrosis factor-alpha (TNF-alpha) by alveolar macrophages, we studied the interaction of Legionella protease and U-937 cells with respect to TNF-alpha. The Legionella protease was purified by fractionated precipitation, gel filtration and hydrophobic interaction chromatography. The purified enzyme was added to U-937 cells, a promyelocytic cell line. In the supernatants of PMA-treated U-937 cells we found low concentrations of TNF-alpha after incubation with protease. Therefore we pursued the hypothesis of direct enzymatic degradation of TNF-alpha by Legionella protease. Enzymatic cleavage of TNF-alpha was proven by SDS-PAGE, ELISA and TNF-alpha bioassay with L-929 cells. The degradation of TNF-alpha by the Legionella protease was shown in all three systems. Enzymatic degradation of TNF-alpha might be important for the pathogenesis of Legionnaires' disease.
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Affiliation(s)
- W Hell
- Institute for Medical Microbiology, Medical University of Lübeck, Germany
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41
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Bohnet S, Huster-Zilz A, Bay A. [Clinical care of children with burns or scalds]. Dtsch Krankenpflegez 1992; 45:768-72. [PMID: 1468372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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42
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Kreft B, Carstensen O, Straube E, Bohnet S, Hacker J, Marre R. Adherence to and cytotoxicity of Escherichia coli for eucaryotic cell lines quantified by MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide). Zentralbl Bakteriol 1992; 276:231-42. [PMID: 1559011 DOI: 10.1016/s0934-8840(11)80010-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adherence of Escherichia coli to human epithelial cells (HEp-2) was studied using MTT (3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium bromide) which is cleaved by enzymes of eucaryotic or procaryotic cells to formazan. This method allows to quantify adherence of Escherichia coli to HEp-2 cells and offers the advantage of assaying a large number of eucaryotic cells without using specific antisera or radioactive material. Furthermore, toxic effects of isolated hemolysin cloned in Escherichia coli onto a renal tubular cell line (LLC-PK1) was investigated by this method, showing reduced cellular viability of tubular cells after an incubation period of 10 to 20 min. MTT is therefore considered to be useful to assay the adherence of Escherichia coli to eucaryotic cells and to quantify toxic effects in eucaryotic cells induced by bacterial virulence factors.
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Affiliation(s)
- B Kreft
- Klinik für Innere Medizin, Medizinische Universität zu Lübeck
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Bohnet S, Rogers L, Sasaki G, Kolattukudy PE. Estradiol induces proliferation of peroxisome-like microbodies and the production of 3-hydroxy fatty acid diesters, the female pheromones, in the uropygial glands of male and female mallards. J Biol Chem 1991; 266:9795-804. [PMID: 2033066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
During the mating season the female mallards produce sex pheromones, diesters of 3-hydroxy fatty acids, in their uropygial glands. Subcellular fractionation by sucrose and Nycodenz density gradient centrifugations and electron microscopic examination of the fractions showed that diesters of 3-hydroxy acids and the enzymes that catalyze the formation and esterification of the 3-hydroxy fatty acids are located in the catalase-containing fractions, probably peroxisomes, whereas monoester synthesizing activities are located in the endoplasmic reticulum. Fatty acyl-CoA reductase that would provide fatty alcohol needed for the synthesis of monoester and diester waxes was found both in the peroxisomal and endoplasmic reticulum fraction. Upon daily intramuscular injection of estradiol into the females in the nonmating season, the short chain monoester waxes of the uropygial glands were replaced by long chain monoester waxes, and subsequently the monoester waxes were replaced by diester waxes. Injection of thyroxine with estradiol hastened the induction of the compositional changes including diester synthesis. Similar changes, including the synthesis of the female pheromones, were induced in the uropygial glands by the hormone treatment of males that do not normally produce diesters at any time during their life cycle. The structure and composition of the diesters induced by hormone treatment of both males and females were identical to those of the female pheromones produced during their mating season. Electron microscopic examination of diaminobenzidine-treated glands showed that peroxisomes proliferated in the gland of the females in the mating season and in the estradiol-treated males that produce the diesters.
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Affiliation(s)
- S Bohnet
- Ohio State Biotechnology Center, Ohio State University, Columbus 43210
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Abstract
Major alterations are induced in muscle cells infected by either Trichinella spiralis or Trichinella pseudospiralis. To investigate the response of muscle to these infections we have analyzed the expression of acid phosphatase (ACP, EC 3.1.3.2), adult skeletal muscle myosin heavy chain, and muscle tropomyosin proteins in infected mouse skeletal muscle cells. Using T. spiralis-infected cells, we provide strong evidence that the tartrate-sensitive ACP of these cells was synthesized by the infected cell and localized in lysosomes. Isoenzyme analysis indicated that the ACP activity was of host muscle cell origin and the specific activity of this ACP was 2.5 times greater than that in associated inflammatory cells. Increased ACP activity was also demonstrated in muscle cells infected by T. pseudospiralis. In synchronized muscle infections, increased ACP activity was detected at 5 days post-muscle infection for both parasites. ACP activity was further increased in infected muscle cells at later times tested. This increased infected cell ACP activity represents the earliest positive enzyme marker yet described indicating expression of the infected cell phenotype. In contrast, myofibrillar proteins were not detected in muscle cells chronically infected by T. spiralis but were detected in muscle cells infected by T. pseudospiralis. Decrease in myofibrillar protein levels was detected by 10 days post-muscle infection by T. spiralis. The data presented demonstrate significant differences and similarities in the phenotypes of muscle cells infected by these two parasites and establish criteria that could facilitate identification of parasite factors that may be involved in these phenomena.
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Affiliation(s)
- D P Jasmer
- Department of Veterinary Microbiology and Pathology, Washington State University, Pullman 99164-7040
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Kolattukudy PE, Bohnet S, Sasaki G, Rogers L. Developmental changes in the expression of S-acyl fatty acid synthase thioesterase gene and lipid composition in the uropygial gland of mallard ducks (Anas platyrhynchos). Arch Biochem Biophys 1991; 284:201-6. [PMID: 1989497 DOI: 10.1016/0003-9861(91)90284-p] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Developmental changes in the composition of the uropygial gland secretory lipids of the postembryonic mallard ducks (Anas platyrhynchos) were determined. During the first 3 weeks after hatching, the composition of the secretory lipids remained constant; the lipids consisted of long-chain wax esters composed of a complex mixture of n-, monomethyl, and dimethyl fatty acids esterified to n-C16 and n-C18 fatty alcohols. Afterward, as the ducks began to acquire adult feathers, short-chain wax esters composed of 2- and 4-monomethyl fatty acids began to appear with 2-methylhexanoyl and 4-methylhexanoyl as the major acyl components; esters of short-chain monomethyl fatty acids (less than or equal to C12) constituted 90% of the lipids when the ducks were 2 months old and had acquired adult plumage. The appearance of the short-chain acids in the acyl portion of the wax esters was accompanied by the appearance of S-acyl fatty acid synthase thioesterase, which can hydrolytically release short-chain acids from fatty acid synthase in the gland. Northern blot analysis showed that the gland-specific thioesterase gene transcripts began to appear in the gland only 3 weeks after hatching. The appearance of the transcripts and immunologically detectable thioesterase protein reached maximum levels 2 months after hatching, with the acquisition of the adult plumage. Thus, the developmental changes in lipid composition correlated with the changes in the level of expression of the thioesterase gene. Expression of other gland-specific genes has been previously found to begin just prior to hatching. The gland-specific thioesterase is the first case of delayed expression of a gland-specific gene.
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Affiliation(s)
- P E Kolattukudy
- Ohio State Biotechnology Center, Ohio State University, Columbus 43210
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Kolattukudy PE, Bohnet S, Rogers L. Diesters of 3-hydroxy fatty acids produced by the uropygial glands of female mallards uniquely during the mating season. J Lipid Res 1987; 28:582-8. [PMID: 3598400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
The uropygial gland secretions produced by female mallards (Anas platyrhynchos) throughout the year were analyzed by thin-layer chromatography and combined gas-liquid chromatography and mass spectrometry. Most of the year, the secretion was composed of wax esters. With the beginning of the mating season in the middle of March, a polar component appeared which became the dominant and sole component of the secretion through April and May and as the mating season ended in June, wax esters became the sole component of the secretion. The polar components were identified to be diesters of n-C8, n-C10, and n-C12 3-hydroxy acids with n-C16 and n-C18 alcohols and n-C6 to C16 even chain acids. Immediately after the diester-producing period the female uropygial glands produced very long chain wax esters composed of fatty acids longer than C12. By the end of August, shorter chain wax esters composed of C6 and C12 acids became the dominant components of the secretion and this composition, previously considered characteristic of mallards, remained constant until March. The observed disappearance of the short chain waxes during the postnuptial period is similar to that in males. The dramatic changes in the composition of the uropygial glands similar to those observed in the female mallards during the mating season have not yet been observed in any other species.
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Kolattukudy PE, Bohnet S, Rogers L. Diesters of 3-hydroxy fatty acids produced by the uropygial glands of female mallards uniquely during the mating season. J Lipid Res 1987. [DOI: 10.1016/s0022-2275(20)38683-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Kolattukudy PE, Bohnet S, Rogers L. Disappearance of short chain acids from the preen gland wax of male mallard ducks during eclipse. J Lipid Res 1985; 26:989-94. [PMID: 4045323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Wax esters constitute the major products of the uropygial glands of male mallard ducks (Anas platyrhynchos). Combined gas-liquid chromatography and mass spectrometry of the acyl and alcohol portions of the wax ester revealed dramatic seasonal variation. Of the total of nearly 100 compounds detected in the acyl portion, more than 90 were identified as n-, monomethyl-, dimethyl-, and trimethyl-C6 to C20 acids. The major components were 2-methyl- and 4-methyl C6 acids which constituted nearly 75% of the total acids during most of the year. As the birds went through the post-nuptial molt into eclipse, these short chain acids decreased to only 4% of the total acids. Fatty acids longer than C12 became the major components during the summer months when the birds were in eclipse and by fall the characteristic shorter branched acids reappeared as the dominant components. Fatty alcohols did not undergo such dramatic changes. This is the first report of biochemical changes that occur during eclipse.
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Kolattukudy PE, Bohnet S, Rogers L. Disappearance of short chain acids from the preen gland wax of male mallard ducks during eclipse. J Lipid Res 1985. [DOI: 10.1016/s0022-2275(20)34303-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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